2024-25 Project (Carreira & Forbes & Bhaskaran)

Severe infection outcomes among cancer survivors in the UK



Dr Helena Carreira at LSHTM
Email: helena.carreira@lshtm.ac.uk


Dr Harriet Forbes at LSHTM
Email: harriet.forbes@lshtm.ac.uk


Professor Krishnan Bhaskaran at LSHTM
Email: krishnan.bhaskaran@lshtm.ac.uk


Project Summary

Thanks to improvements and in cancer detection and treatment, many people now live for years or decades after a cancer diagnosis. However, there is a need to better understand the potential medium- and long-term adverse effects of cancer and its treatments. Infections are a significant cause of morbidity and mortality in cancer survivors, and some types of cancer may be associated with immune system damage, but there is a lack of good evidence on the links between history of cancer and risk of infections.    

This project aims to capitalise on the research opportunities presented by large-scale databases of routinely-collected electronic health records data to better understand the association between cancer survivorship and infection. The student will access large linked health datasets from the UK. The project will involve addressing key methodological challenges, including deriving appropriate analysis-ready variables from messy real-world data, identifying optimal comparison groups, and dealing with statistical problems such as repeated measures and competing risks. The student will then apply optimal methodology to investigate whether cancer survivors have an increased risk of infection, and poorer outcomes following infection.

Project Key Words

Electronic health records; Cancer; Infections; Outcomes research.

MRC LID Themes

  • Global Health = Yes
  • Health Data Science = Yes
  • Infectious Disease = Yes
  • Translational and Implementation Research = No


MRC Core Skills

  • Quantitative skills = Yes
  • Interdisciplinary skills = Yes
  • Whole organism physiology = No

Skills we expect a student to develop/acquire whilst pursuing this project

– Obtaining ethical approvals to utilise electronic healthcare data 
– Designing epidemiological studies 
– Management of large-scale healthcare datasets 
– Advanced coding in software packages such as STATA  
– Advanced statistical analysis of longitudinal data  
– Identifying best methods to deal with confounding and bias in electronic healthcare record data 
– Writing papers for publications 
– Presenting scientific work at relevant conferences 
– Engaging with the public and patients to develop and disseminate their work


Which route/s is this project available for?

  • 1+4 = No
  • +4 = Yes

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes


Particular prior educational requirements for a student undertaking this project

  • LSHTM’s standard institutional eligibility criteria for doctoral study.
  • MSc in Epidemiology, Medical Statistics, Health Data Sciences.

Other useful information

  • Potential CASE conversion? = No


Scientific description of this research project

Project objectives:
Infections are a leading cause of death in cancer survivors, and some cancers and their treatments may adversely affect the immune system. Large-scale routinely collected health data provide an opportunity to strengthen the evidence on how a history of cancer is associated with infection risk and infection outcomes, but these data present several statistical and data management challenges. The aim of this project is to address these key methodological problems, then to apply optimal methodology to understand whether people who have had cancer have more infections and/or are more likely to be admitted to hospital or die because of infections.   

Techniques to be used:
To better understand infections in cancer survivors, this project will use linked data from multiple databases of routinely collected data in the UK, including electronic health records from patients attending primary care (available from the Clinical Practice Research Datalink), hospital admissions (Hospital Episode Statistics (HES) database) and officially recorded mortality data from the Office for National Statistics.  The student will develop case definitions and algorithms to identify from clinical records which patients have had a cancer diagnosis and subsequently had an infection. This will include differentiating between infection types (pulmonary, gastrointestinal, genitourinary, skin, bacteraemia), identifying sepsis and hospitalisation for infection, and developing strategies to deal with changes in the incidence/recording of infections during the COVID-19 pandemic.  The student will then apply the latest epidemiological and statistical methods to compare risks of infection, and risks of severe infection outcomes, between those people with and without a history of cancer. Methodological challenges will include identifying suitable non-cancer comparison groups, accounting for competing risks in analysis, and dealing with repeated infections.   

Confirmed availability of any required databases:
LSHTM holds a multi-study license to access the CPRD primary care database which includes access to linked hospital data (subject to annual renewal). Data access is still subject to project approval from CPRD’s Research Data Governance Process.    

Potential risk to the project and plans for their mitigation:
In theory, there is a risk of a shortfall in funding preventing renewal of the LSHTM CPRD licence. However, we have successfully covered the licence costs through EHR group grants/funds for >10 years, and we have already sourced enough funds to cover the 2023-4 licence period. We have budgeted for a contribution to licence costs from the RTSG; a fall-back option would be to instead use these funds to access alternative data resources for this specific project, such as The Health Improvement Network (THIN), OpenSAFELY, or relevant cohort data such as UK Biobank. An additional threat to this project is the lack of protocol approval following CPRD’s Research Data Governance Process. However, the supervisory team has vast experience in successfully obtaining approvals for studies, with virtually every research protocol eventually progressing to approval.

Further reading

(Relevant preprints and/or open access articles)

Additional information from the supervisory team

  • The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.
    Carreira & Forbes & Bhaskaran Recording


Comments are closed.